tbuckley/cabot-search huggingface dataset:
Analysis of Pregnancy-Related Attacks in Neuromyelitis Optica Spectrum Disorder
Authors: Liang Wang, Manqiqige Su, Zhirui Zhou, Lei Zhou, Jingzi ZhangBao, Hongmei Tan, Wenjuan Huang, Xuechun Chang, Chuanzhen Lu, Jian Yu, Min Wang, Jiahong Lu, Chongbo Zhao, Tiansong Zhang, Chao Quan
Journal: JAMA Network Open (2022)

<h3>Importance</h3> Risk of relapse may be increased in the postpartum period of neuromyelitis optica spectrum disorder (NMOSD). Information regarding factors associated with pregnancy-related attacks is still lacking. <h3>Objectives</h3> To identify factors associated with pregnancy-related NMOSD attacks, investigate the integrated annualized relapse rate (ARR) and Expanded Disability Status Scale (EDSS) score in each phase of pregnancy, and summarize pregnancy outcomes and complications in patients with NMOSD. <h3>Data Sources</h3> An electronic search was performed in the MEDLINE, PubMed in-process and non-MEDLINE, EMBASE, Web of Science, and Cochrane databases using the OvidSP search platform, updated through December 30, 2021. <h3>Study Selection</h3> All published and unpublished studies in English were considered, covering all patients with NMOSD with an informative pregnancy. <h3>Data Extraction and Synthesis</h3> Two independent reviewers extracted the published data with a standardized procedure following MOOSE and PRISMA guidelines. The end points were calculated with the DerSimonian and Laird inverse variance (for random effects) method. <h3>Main Outcomes and Measures</h3> The primary outcome was the rate of pregnancies with pregnancy-related NMOSD attacks, measured by risk ratios (RRs). The mean differences (MDs) in ARR and EDSS scores between each phase of pregnancy, pregnancy outcomes, and complications were defined as the secondary outcomes. <h3>Results</h3> A total of 15 studies were analyzed, including 443 patients with NMOSD with 639 informative pregnancies. Patients receiving immunosuppressive treatment during pregnancy (RR, 0.43; 95% CI, 0.32-0.57;<i>P</i> &lt; .001) and with older age at conception (RR, 0.67; 95% CI, 0.47-0.95;<i>P</i> = .02) had lower rates of pregnancy with pregnancy-related attacks. The increase in the ARR was highest in the first trimester after delivery compared with before pregnancy (MD, 1.28; 95% CI, 0.94-1.62;<i>P</i> &lt; .001). The EDSS scores increased significantly both during pregnancy (MD, 0.44; 95% CI, 0.20-0.69;<i>P</i> &lt; .001) and in the postpartum period (MD, 0.88; 95% CI, 0.51-1.26;<i>P</i> &lt; .001) compared with before pregnancy. <h3>Conclusions and Relevance</h3> This systematic review and meta-analysis found that receiving immunosuppressive treatment during pregnancy and older age at conception were associated with reduced risk of pregnancy-related NMOSD attacks, which mostly occurred in the first trimester of the postpartum period, although more high-quality prospective studies are needed.
Child Deaths by Gun Violence in the US During the COVID-19 Pandemic
Authors: Pablo A. Peña, Anupam Jena
Journal: JAMA Network Open (2022)

Figure presents 28-day moving averages.The moving average includes fewer than 28 but at least 14 days at the start and the end of the period covered.Children included were aged 0 to 17 years.The vertical line indicates March 16, 2020.
SARS-CoV-2 Infections, Hospitalizations, and Mortality in Vaccinated Patients With Cancer in the US
Authors: Yung-Shuo Kao, James Cheng-Chung Wei, Chih-Jung Yeh
Journal: JAMA Oncology (2022)

To the Editor We read with great interest the recently published cohort study in JAMA Oncology by Wang et al.1 This study demonstrated that patients with cancer had a higher incidence of breakthrough SARS-CoV-2 infection. The result is interesting; however, we want to point out some concerns.
Immunotherapy After Chemotherapy and Radiation for Clinical Stage III Lung Cancer
Authors: Matthew D. Pichert, Maureen E. Canavan, Richard C. Maduka, Andrew X. Li, Theresa Ermer, Peter L. Zhan, Michael Kaminski, Brooks V. Udelsman, Justin D. Blasberg, Henry S. Park, Sarah B. Goldberg, Daniel J. Boffa
Journal: JAMA Network Open (2022)

<h3>Importance</h3> The 2017 international PACIFIC trial established a role for immunotherapy after chemoradiation for unresectable stage III non–small cell lung cancer (NSCLC). However, in the US, patients with NSCLC commonly differ from clinical trial populations in terms of age, health, access to care, and treatment course, which may all factor into the efficacy of immunotherapy. <h3>Objective</h3> To determine the outcomes of immunotherapy use in unresectable stage III NSCLC in the general US population. <h3>Design, Setting, and Participants</h3> This cohort study analyzed the National Cancer Database for patients diagnosed with clinical stage III NSCLC between 2015 and 2017 with follow-up through the end of 2018 who were treated with chemotherapy and radiation. Data were analyzed January 2022. <h3>Main Outcomes and Measures</h3> Mortality hazard in a multivariable Cox proportional hazards model and survival among a propensity-matched sample treated with chemotherapy and radiation, with and without immunotherapy. <h3>Results</h3> A total of 23 811 patients with clinical stage III NSCLC with median (IQR) age 66 (59-72) years met inclusion criteria (10 454 [43.9%] women; 564 [2.4%] Asian, 2930 [12.3%] Black, 20 077 [84.3%] White patients), including 209 (16.1%) patients with multiple comorbidities and 1297 (5.4%) immunotherapy recipients. Immunotherapy after chemotherapy and radiation was associated with reduced mortality (hazard ratio [HR], 0.74; 95% CI, 0.67-0.82;<i>P</i> &lt; .001). Among a propensity-matched sample, immunotherapy was associated with superior 3-year survival (52% [1297 patients at 0 months, 56 patients at 36 months] vs 44% [2594 patients at 0 months, 173 patients at 36 months];<i>P</i> &lt; .001). The treatment of 833 patients who received immunotherapy (64.2%) differed from the PACIFIC trial protocol, including 221 patients (17.0%) who received radiation doses outside of the protocol range and 731 patients (56.4%) who started immunotherapy more than 6 weeks after radiation was completed. The survival advantage of immunotherapy persisted when initiated up to 12 weeks after radiation was completed (HR, 0.75; 95% CI, 0.61-0.92). Among patients who received radiation outside the PACIFIC protocol range, the survival advantage of immunotherapy was not significant (HR, 0.87; 95% CI, 0.69-1.01). <h3>Conclusions and Relevance</h3> In this cohort study, immunotherapy after chemotherapy and radiation for stage III NSCLC was associated with a survival advantage in the general US population despite two-thirds of patients treated differently than the PACIFIC protocol. The findings suggest there may be flexibility in the timing of immunotherapy initiation after radiation; further study is warranted to clarify the clinical benefits of immunotherapy.
Interim Recommendation of the Advisory Committee on Immunization Practices for Use of the Novavax COVID-19 Vaccine in Persons Aged ≥18 years — United States, July 2022
Authors: Evelyn Twentyman, Megan Wallace, Lauren E. Roper, Tara C. Anderson, Amy B. Rubis, Katherine E. Fleming-Dutra, Elisha Hall, Joy Hsu, Hannah G. Rosenblum, Monica Godfrey, W. Roodly Archer, Danielle L. Moulia, Laura Daniel, Oliver Brooks, H. Keipp Talbot, Grace M. Lee, Beth P. Bell, Matthew Daley, Sarah Meyer, Sara E. Oliver
Journal: MMWR Morbidity and Mortality Weekly Report (2022)

The NVX-CoV2373 (Novavax) COVID-19 vaccine is a recombinant spike (rS) protein nanoparticle vaccine with Matrix-M adjuvant to protect against infection with SARS-CoV-2, the virus that causes COVID-19. On July 13, 2022, the Food and Drug Administration (FDA) issued Emergency Use Authorization (EUA) for the Novavax vaccine for primary COVID-19 immunization of unvaccinated adults aged ≥18 years, administered as 2 doses (5 μg rS and 50 μg Matrix-M adjuvant in each dose) 3 weeks apart (1). On July 19, 2022, the Advisory Committee on Immunization Practices (ACIP) issued an interim recommendation for use of the Novavax vaccine in persons aged ≥18 years for the prevention of COVID-19.* In the per-protocol† efficacy analysis, vaccine efficacy (VE) against reverse transcription-polymerase chain reaction (RT-PCR)-confirmed symptomatic COVID-19 was 89.6% (95% CI = 82.4%-93.8%). The Alpha variant (B.1.1.7) of SARS-CoV-2 was the predominant circulating variant during the period of case accrual for VE assessments. Cases of myocarditis or pericarditis were reported in temporal association with vaccination, suggesting a possible causal relationship. The ACIP recommendation for the use of the Novavax COVID-19 vaccine is interim and will be updated as additional information becomes available. The adjuvanted, protein subunit-based Novavax COVID-19 vaccine provides an additional option for unvaccinated adults, increasing flexibility for the public and for vaccine providers. Vaccination is important for protection against COVID-19.
Post–COVID-19 Symptoms and Conditions Among Children and Adolescents — United States, March 1, 2020–January 31, 2022
Authors: Lyudmyla Kompaniyets, Lara Bull-Otterson, Tegan K. Boehmer, Sarah Baca, Pablo Alvarez, Kai Hong, Joy Hsu, Aaron M. Harris, Adi V. Gundlapalli, Sharon Saydah
Journal: MMWR Morbidity and Mortality Weekly Report (2022)

Post-COVID-19 (post-COVID) symptoms and conditions* are new, recurring, or ongoing health problems that occur 4 or more weeks after infection with SARS-CoV-2 (the virus that causes COVID-19). Previous studies have characterized and estimated the incidence of post-COVID conditions among adults (1,2), but data among children and adolescents are limited (3-8). Using a large medical claims database, CDC assessed nine potential post-COVID signs and symptoms (symptoms) and 15 potential post-COVID conditions among 781,419 U.S. children and adolescents aged 0-17 years with laboratory-confirmed COVID-19 (patients with COVID-19) compared with 2,344,257 U.S. children and adolescents without recognized COVID-19 (patients without COVID-19) during March 1, 2020-January 31, 2022. The analysis identified several symptoms and conditions with elevated adjusted hazard ratios among patients with COVID-19 (compared with those without). The highest hazard ratios were recorded for acute pulmonary embolism (adjusted hazard ratio [aHR] = 2.01), myocarditis and cardiomyopathy (1.99), venous thromboembolic event (1.87), acute and unspecified renal failure (1.32), and type 1 diabetes (1.23), all of which were rare or uncommon in this study population. Conversely, symptoms and conditions that were most common in this study population had lower aHRs (near or below 1.0). Patients with COVID-19 were less likely than were patients without to experience respiratory signs and symptoms, symptoms of mental conditions, muscle disorders, neurological conditions, anxiety and fear-related disorders, mood disorders, and sleeping disorders. COVID-19 prevention strategies, including vaccination for all eligible children and adolescents, are critical to prevent SARS-CoV-2 infection and subsequent illness, including post-COVID symptoms and conditions (9).
Prognostic Value of Exercise as Compared to Resting Pulmonary Hemodynamics in Patients with Normal or Mildly Elevated Pulmonary Arterial Pressure
Authors: Philipp Douschan, Alexander Avian, Vasile Foris, Teresa Sassmann, Gerhard Bachmaier, Piet Rosenstock, Katarina Zeder, Horst Olschewski, Gabor Kovacs
Journal: American Journal of Respiratory and Critical Care Medicine (2022)
FDA Approval Summary: Pembrolizumab for Neoadjuvant and Adjuvant Treatment of Patients with High-Risk Early-Stage Triple-Negative Breast Cancer
Authors: Mirat Shah, Christy L. Osgood, Anup K. Amatya, Mallorie H. Fiero, William F. Pierce, Abhilasha Nair, Jonathan Herz, Kim J. Robertson, Bronwyn D. Mixter, Shenghui Tang, Richard Pazdur, Julia A. Beaver, Laleh Amiri-Kordestani
Journal: Clinical Cancer Research (2022)

Abstract On July 26, 2021, the FDA granted approval to pembrolizumab in combination with chemotherapy for neoadjuvant treatment and then continued as a single agent for adjuvant treatment following surgery for patients with high-risk, early-stage triple-negative breast cancer. Approval was based on results from KEYNOTE-522, an ongoing randomized (2:1) trial evaluating pembrolizumab or placebo in combination with chemotherapy for neoadjuvant treatment and then as a single agent for adjuvant treatment. The co-primary endpoints were pathological complete response (pCR) rate and event-free survival (EFS). The trial demonstrated an improvement in pCR and EFS in the pembrolizumab arm compared with the control arm. The number of patients who experienced an EFS event was 123 (16%) and 93 (24%), respectively [HR: 0.63, 95% confidence interval (CI), 0.48–0.82, P = 0.00031]. Patients on the pembrolizumab arm experienced EFS benefit regardless of tumor PD-L1 status. The absolute pCR rate improvement with the addition of pembrolizumab was 7.5% (95% CI, 1.6–13.4). Among patients receiving pembrolizumab, 44% experienced an immune-related adverse reaction. This article summarizes FDA's review of pembrolizumab and the data supporting the favorable benefit–risk assessment.
Synaptic-like axo-axonal transmission from striatal cholinergic interneurons onto dopaminergic fibers
Authors: Paul F. Kramer, Samuel G. Brill-Weil, Alex C. Cummins, Renshu Zhang, Gisela A. Camacho-Hernandez, Amy H. Newman, Mark A.G. Eldridge, Bruno B. Averbeck, Zayd M. Khaliq
Journal: Neuron (2022)

Transmission from striatal cholinergic interneurons (CINs) controls dopamine release through nicotinic acetylcholine receptors (nAChRs) on dopaminergic axons. Anatomical studies suggest that cholinergic terminals signal predominantly through non-synaptic volume transmission. However, the influence of cholinergic transmission on electrical signaling in axons remains unclear. We examined axo-axonal transmission from CINs onto dopaminergic axons using perforated-patch recordings, which revealed rapid spontaneous EPSPs with properties characteristic of fast synapses. Pharmacology showed that axonal EPSPs (axEPSPs) were mediated primarily by high-affinity α6-containing receptors. Remarkably, axEPSPs triggered spontaneous action potentials, suggesting that these axons perform integration to convert synaptic input into spiking, a function associated with somatodendritic compartments. We investigated the cross-species validity of cholinergic axo-axonal transmission by recording dopaminergic axons in macaque putamen and found similar axEPSPs. Thus, we reveal that synaptic-like neurotransmission underlies cholinergic signaling onto dopaminergic axons, supporting the idea that striatal dopamine release can occur independently of somatic firing to provide distinct signaling.
Clinical use of artificial intelligence in endometriosis: a scoping review
Authors: Brintha Sivajohan, Mohamed Elgendi, Carlo Menon, Catherine Allaire, Paul Yong, Mohamed A. Bedaiwy
Journal: npj Digital Medicine (2022)

Abstract Endometriosis is a chronic, debilitating, gynecologic condition with a non-specific clinical presentation. Globally, patients can experience diagnostic delays of ~6 to 12 years, which significantly hinders adequate management and places a significant financial burden on patients and the healthcare system. Through artificial intelligence (AI), it is possible to create models that can extract data patterns to act as inputs for developing interventions with predictive and diagnostic accuracies that are superior to conventional methods and current tools used in standards of care. This literature review explored the use of AI methods to address different clinical problems in endometriosis. Approximately 1309 unique records were found across four databases; among those, 36 studies met the inclusion criteria. Studies were eligible if they involved an AI approach or model to explore endometriosis pathology, diagnostics, prediction, or management and if they reported evaluation metrics (sensitivity and specificity) after validating their models. Only articles accessible in English were included in this review. Logistic regression was the most popular machine learning method, followed by decision tree algorithms, random forest, and support vector machines. Approximately 44.4% ( n = 16) of the studies analyzed the predictive capabilities of AI approaches in patients with endometriosis, while 47.2% ( n = 17) explored diagnostic capabilities, and 8.33% ( n = 3) used AI to improve disease understanding. Models were built using different data types, including biomarkers, clinical variables, metabolite spectra, genetic variables, imaging data, mixed methods, and lesion characteristics. Regardless of the AI-based endometriosis application (either diagnostic or predictive), pooled sensitivities ranged from 81.7 to 96.7%, and pooled specificities ranged between 70.7 and 91.6%. Overall, AI models displayed good diagnostic and predictive capacity in detecting endometriosis using simple classification scenarios (i.e., differentiating between cases and controls), showing promising directions for AI in assessing endometriosis in the near future. This timely review highlighted an emerging area of interest in endometriosis and AI. It also provided recommendations for future research in this field to improve the reproducibility of results and comparability between models, and further test the capacity of these models to enhance diagnosis, prediction, and management in endometriosis patients.
<i>Notes from the Field:</i> Increase in Pediatric Intracranial Infections During the COVID-19 Pandemic — Eight Pediatric Hospitals, United States, March 2020–March 2022
Authors: Daliya Khuon, Sara Ogrin, Julie Engels, Aileen Aldrich, Rosemary M. Olivero
Journal: MMWR Morbidity and Mortality Weekly Report (2022)
Outbreaks of Acute Gastrointestinal Illness Associated with a Splash Pad in a Wildlife Park — Kansas, June 2021
Authors: Samaria K. Aluko, Syed S. Ishrati, David C. Walker, Mia C. Mattioli, Amy M. Kahler, Kayla L. Vanden Esschert, Kaylee Hervey, Justin Rokisky, Mary E. Wikswo, Joseph P. Laco, Sonalli Kurlekar, Adrienne Byrne, Noelle-Angelique Molinari, Michelle E. Gleason, Christine Steward, Michele C. Hlavsa, Daniel Neises
Journal: MMWR Morbidity and Mortality Weekly Report (2022)

In June 2021, Kansas state and county public health officials identified and investigated three cases of shigellosis (a bacterial diarrheal illness caused by Shigella spp.) associated with visiting a wildlife park. The park has animal exhibits and a splash pad. Two affected persons visited animal exhibits, and all three entered the splash pad. Nonhuman primates are the only known animal reservoir of Shigella. The splash pad, which sprays water on users and is designed so that water does not collect in the user area, was closed on June 19. The state and county public health codes do not include regulations for splash pads. Thus, these venues are not typically inspected, and environmental health expertise is limited. A case-control study identified two distinct outbreaks associated with the park (a shigellosis outbreak involving 21 cases and a subsequent norovirus infection outbreak involving six cases). Shigella and norovirus can be transmitted by contaminated water; in both outbreaks, illness was associated with getting splash pad water in the mouth (multiply imputed adjusted odds ratio [aORMI] = 6.4, p = 0.036; and 28.6, p = 0.006, respectively). Maintaining adequate water disinfection and environmental health expertise and targeting prevention efforts to caregivers of splash pad users help prevent splash pad-associated outbreaks. Outbreak incidence might be further reduced when U.S. jurisdicitons voluntarily adopt CDC's Model Aquatic Health Code (MAHC) recommendations and through the prevention messages: "Don't get in the water if sick with diarrhea," "Don't stand or sit above the jets," and "Don't swallow the water."†.
Risk of covid-19 related deaths for SARS-CoV-2 omicron (B.1.1.529) compared with delta (B.1.617.2): retrospective cohort study
Authors: Isobel L Ward, Charlotte Bermingham, Daniel Ayoubkhani, Owen J Gethings, Koen B Pouwels, Thomas Yates, Kamlesh Khunti, Julia Hippisley-Cox, Amitava Banerjee, Ann Sarah Walker, Vahé Nafilyan
Journal: BMJ (2022)

Abstract Objective To assess the risk of covid-19 death after infection with omicron BA.1 compared with delta (B.1.617.2). Design Retrospective cohort study. Setting England, United Kingdom, from 1 December 2021 to 30 December 2021. Participants 1 035 149 people aged 18-100 years who tested positive for SARS-CoV-2 under the national surveillance programme and had an infection identified as omicron BA.1 or delta compatible. Main outcome measures The main outcome measure was covid-19 death as identified from death certification records. The exposure of interest was the SARS-CoV-2 variant identified from NHS Test and Trace PCR positive tests taken in the community (pillar 2) and analysed by Lighthouse laboratories. Cause specific Cox proportional hazard regression models (censoring non-covid-19 deaths) were adjusted for sex, age, vaccination status, previous infection, calendar time, ethnicity, index of multiple deprivation rank, household deprivation, university degree, keyworker status, country of birth, main language, region, disability, and comorbidities. Interactions between variant and sex, age, vaccination status, and comorbidities were also investigated. Results The risk of covid-19 death was 66% lower (95% confidence interval 54% to 75%) for omicron BA.1 compared with delta after adjusting for a wide range of potential confounders. The reduction in the risk of covid-19 death for omicron compared with delta was more pronounced in people aged 18-59 years (number of deaths: delta=46, omicron=11; hazard ratio 0.14, 95% confidence interval 0.07 to 0.27) than in those aged ≥70 years (number of deaths: delta=113, omicron=135; hazard ratio 0.44, 95% confidence interval 0.32 to 0.61, P&lt;0.0001). No evidence of a difference in risk was found between variant and number of comorbidities. Conclusions The results support earlier studies showing a reduction in severity of infection with omicron BA.1 compared with delta in terms of hospital admission. This study extends the research to also show a reduction in the risk of covid-19 death for the omicron variant compared with the delta variant.
Recent advances in clinical practice: advances in cross-sectional imaging in inflammatory bowel disease
Authors: Jordi Rimola, Joana Torres, Shankar Kumar, Stuart A Taylor, Torsten Kucharzik
Journal: Gut (2022)

Endoscopy remains the reference standard for the diagnosis and assessment of patients with inflammatory bowel disease (IBD), but it has several important limitations. Cross-sectional imaging techniques such as magnetic resonance enterography (MRE) and intestinal ultrasound (IUS) are better tolerated and safer. Moreover, they can examine the entire bowel, even in patients with stenoses and/or severe inflammation. A variety of cross-sectional imaging activity scores strongly correlate with endoscopic measures of mucosal inflammation in the colon and terminal ileum. Unlike endoscopy, cross-sectional techniques allow complete visualisation of the small-bowel and assess for extraintestinal disease, which occurs in nearly half of patients with IBD. Extramural findings may predict outcomes better than endoscopic mucosal assessment, so cross-sectional techniques might help identify more relevant therapeutic targets. Coupled with their high sensitivity, these advantages have made MRE and IUS the primary non-invasive options for diagnosing and monitoring Crohn’s disease; they are appropriate first-line investigations, and have become viable alternatives to colonoscopy. This review discusses cross-sectional imaging in IBD in current clinical practice as well as research lines that will define the future role of these techniques.